TY - JOUR
T1 - Role and significance of quantitative urine cultures in diagnosis of melioidosis
AU - Limmathurotsakul, Direk
AU - Wuthiekanun, Vanaporn
AU - Chierakul, Wirongrong
AU - Cheng, Alien C.
AU - Maharjan, Bina
AU - Chaowagul, Wipada
AU - White, Nicholas J.
AU - Day, Nicholas P.J.
AU - Peacock, Sharon J.
PY - 2005/5
Y1 - 2005/5
N2 - Melioidosis is associated with significant mortality in countries in which it is endemic. Previous studies have demonstrated that quantitative Burkholderia pseudomallei counts in blood are predictive of mortality. Here we examine the relationship between outcomes and quantitative B. pseudomallei counts in urine. A total of 755 patients presenting to Sappasithiprasong Hospital, Ubon Ratchathani, northeast Thailand (in the northeast part of the country), with melioidosis between July 1993 and October 2003 had quantitative urine cultures performed within 72 h of admission. Urine culture results were divided into the following groups: (i) no growth of β. pseudomallei from a neat sample or pellet, (ii) positive result from a centrifuged pellet only (<103 CFU/ml), (iii) detection of between 103 CFU/ml and 105 CFU/ml from a neat sample, or (iv) detection of >105 CFU/ml from a neat sample. The overall in-hospital mortality rate was 45%. Patients with negative urine cultures had the lowest death rate (39%). Mortality rates rose with increasing B. pseudomallei counts in urine, from 58% for those with positive spun pellets only to 61% for those with between 103 CFU/ml and 105 CFU/ml and 71% for those with ≥105 CFU/ml. This was independent of age, presence of bacteremia, known risk factors for melioidosis such as diabetes, and the prior administration of antibiotics. The presence of B. pseudomallei in urine during systemic infection is associated with a poor prognosis.
AB - Melioidosis is associated with significant mortality in countries in which it is endemic. Previous studies have demonstrated that quantitative Burkholderia pseudomallei counts in blood are predictive of mortality. Here we examine the relationship between outcomes and quantitative B. pseudomallei counts in urine. A total of 755 patients presenting to Sappasithiprasong Hospital, Ubon Ratchathani, northeast Thailand (in the northeast part of the country), with melioidosis between July 1993 and October 2003 had quantitative urine cultures performed within 72 h of admission. Urine culture results were divided into the following groups: (i) no growth of β. pseudomallei from a neat sample or pellet, (ii) positive result from a centrifuged pellet only (<103 CFU/ml), (iii) detection of between 103 CFU/ml and 105 CFU/ml from a neat sample, or (iv) detection of >105 CFU/ml from a neat sample. The overall in-hospital mortality rate was 45%. Patients with negative urine cultures had the lowest death rate (39%). Mortality rates rose with increasing B. pseudomallei counts in urine, from 58% for those with positive spun pellets only to 61% for those with between 103 CFU/ml and 105 CFU/ml and 71% for those with ≥105 CFU/ml. This was independent of age, presence of bacteremia, known risk factors for melioidosis such as diabetes, and the prior administration of antibiotics. The presence of B. pseudomallei in urine during systemic infection is associated with a poor prognosis.
UR - http://www.scopus.com/inward/record.url?scp=18544371367&partnerID=8YFLogxK
U2 - 10.1128/JCM.43.5.2274-2276.2005
DO - 10.1128/JCM.43.5.2274-2276.2005
M3 - Article
C2 - 15872255
AN - SCOPUS:18544371367
SN - 0095-1137
VL - 43
SP - 2274
EP - 2276
JO - Journal of Clinical Microbiology
JF - Journal of Clinical Microbiology
IS - 5
ER -
